In today’s lesson, we address the worst possible study habit for MBLEx preparation, memorizing practice questions!
Because MBLEx questions are not released to the public, I can promise that you won’t be seeing any of your practice questions on the live test, regardless of your study source. Even if you had access to the MBLEx database, it’s impossible to memorize thousands of questions and answers.
What to Do When You Don’t Know the Answer
There are going to be questions on your exam where you will immediately know the answer. However, there will be a lot of questions where you won’t. For each of these, you need to be able to:
- Locate the relevant information in the question.
- Apply your foundational knowledge to eliminate possible answers.
- Choose the best answer from the remaining choices.
Let’s take a look at some examples of how to do this.
Category: Pathology, Contraindications
A 60-year-old female client reports she was recently diagnosed with hypothyroidism. She has been prescribed daily dose of synthroid (25-50 mcg/day) by her physician. She would like a relaxation massage, with a majority of the time focused on her neck and shoulder area. Which of the following should be part of your session plan?
- Recommend a natural thyroid supplement (example: coconut oil or lemongrass) to use in addition Synthroid.
- Keep in close communication with the client about room temperature. Hypothyroidism causes cold sensitivity. Provide a warm environment and additional blankets, if requested.
- Because the client is taking Synthroid, have them reschedule today’s massage after the course of medication is finished and she is released by her physician.
- Keep in close communication with the client about room temperature. Hypothyroidism causes overheating. Keep the room cool and prepare to use minimal draping.
Breaking Down the Question
Your client, a 60-year-old woman, has recently been diagnosed with hypothyroidism. This is a common age and gender for a diagnosis of this disease. The most important part of the question is her diagnosis.
What is hypothyroidism?
Hypothyroidism is an underactive thyroid gland. The thyroid gland (part of the endocrine system) fails to produce enough of the hormone, T4 (thyroxine).
What are the symptoms of hypothyroidism?
Major symptoms of hypothyroidism include fatigue, cold sensitivity, constipation, heavy periods, dry skin, and unexplained weight gain.
Does hypothyroidism contraindicate massage?
Is massage indicated for hypothyroidism?
Massage may be used to promote general wellness and relieve symptoms of hypothyroidism (constipation or fatigue).
We also learn about her new medication, Synthroid.
What is Synthroid?
Synthroid is a common prescription medication used to treat hypothyroidism. The active ingredient in Synthroid is levothyroxine sodium. It is a synthetic hormone, identical to thyroxine. Other synthetic thyroxine medications include Levoxyl and Levothyroid.
What are the implications of Synthroid for massage?
There are no contraindications for thyroxine medications and massage according to most massage texts. Here is an article about massage for clients with hypothyroidism by pathology expert, Ruth Werner.
With this information, let’s revisit our choices.
A. Recommend a natural thyroid supplement (example: coconut oil) to use in addition or in place of synthroid.
Recommending or prescribing are always bright red scope of practice flags. It is never appropriate to diagnose or prescribe anything, even natural, to a client. Ever. Even recommending a supplement is not encouraged.
Prescribing and diagnosing are outside the massage scope of practice. There are currently no studies that show coconut oil cures an under-active thyroid. Even if their were, the client would need to discuss this with their doctor.
Massage professionals also should not recommend, or encourage, clients to reduce dosages or discontinue prescriptions.
This choice can be quickly eliminated.
C. Because the client is taking Synthroid, have the client reschedule the massage after the course of medication is finished and she is released by her physician.
There are very, very few medications that contraindicate massage, which should help you eliminate this choice. Generally, thyroid replacement medications are taken for life. Taking Synthroid is not a contraindication for massage.
This choice can be eliminated.
D. Keep in close communication with the client about room temperature. Hypothyroidism causes overheating. Keep the room cool and prepare to use minimal draping.
This answer is the opposite of Choice B. It is meant to make you think, “do people with hypothyroidism run cold or warm?” Hyperthyroidism symptoms include heat sensitivity, not hypothyroidism.
B. Keep in close communication with the client about room temperature. Hypothyroidism causes cold sensitivity. Provide a warm environment and additional blankets, if requested.
A common symptom of hypothyroidism is cold sensitivity. In a situation, like a massage, where a client may have minimal clothing, it is important to keep in close communication with the client about the room temperature. To keep a client warm, offer additional blankets or heating pads.
Choice B is the correct and best answer.
A 62-year-old client with chronic bronchitis reports minor muscular pain in his back. Onset of pain occurred during a coughing spell he had last week. He reports no other illnesses, or signs of an acute respiratory infection. What is the appropriate response?
- Reschedule massage after chronic bronchitis has completely resolved.
- Refer to Primary Health Provider (PHP) for further care.
- Proceed with massage.
- Proceed with massage, but avoid locally contraindicated areas of the upper back and anterior chest.
Breaking Down the Question
What is chronic bronchitis?
Chronic bronchitis is a long term (3 months to years) inflammation of the bronchi. It is not treatable with antibiotics.
Acute bronchitis is an active infection that often accompanies the common cold. The infection often resolves within 10 days, but the cough can linger for weeks.
Does chronic bronchitis contraindicate massage?
Massage is appropriate for chronic bronchitis if the client has no other contraindications or symptoms of an acute respiratory infection.
This differs from the protocol for acute bronchitis. In general, all acute infections contraindicate massage. After the infection or inflammation has resolved, massage may be appropriate during recovery of acute bronchitis.
Let’s revisit the choices.
A. Reschedule massage after chronic bronchitis has completely resolved.
It is not necessary to reschedule the massage since this condition is not a contraindication for massage.
B. Refer to PHP for further care.
The client does not seem to have any additional health concerns that warrant a referral to PHP.
C. Proceed with massage since acute respiratory infection is not present.
Studies consistently show that massage benefits the respiratory system and aides in recovery from soft tissue injuries, such as muscle strains.
D. Proceed with massage, but avoid upper back and chest.
Chronic bronchitis is not a local contraindication. There is no need to avoid these areas unless requested by the client.
In this question, the best answer is C.
Further reading for this question.
Category: Client Assessment
How would you palpate the Subscapularis muscle?
- Have the subject lie in prone position and hang their arm over the edge of the table. Place your fingers superior to the spine of the scapula. When abduction of the arm is carried out in this position, the contraction of the Subscapularis muscle may be felt.
- Have the client stand erect and abduct their arm while holding a small weight. Place your fingers superior to the spine of the scapula to feel the contraction of subscapularis.
- Have the client lie in prone position with the arm hanging vertically. The margin of the posterior deltoid should be identified. The palpating fingers are placed below the deltoid on the scapula, near its lateral margin. While the client maintains his arm in a vertical position, request that he demonstrate lateral rotation of the shoulder. The Subscapularis then rises under the palpating fingers.
- Have the client’s trunk inclined forward so that the scapula slides forward on the rib cage by the weight of the hanging arm. In this position, you may already palpate a portion of the Subscapularis muscle. The fingers are then placed in the axilla anterior to the latissimus dorsi, and with gentle pressure, are moved into the costal surface of the scapula. With the arm hanging vertically, the client then medially rotates the shoulder. The firm, round belly of the subscapularis can be felt rising under the palpating fingers.
Breaking Down the Question
The Rotator Cuff group of muscles consists of the Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. All four muscles function to connect the scapula to the humerus and stabilize the shoulder joint.
Let’s review the choices.
A. Have the subject lie in prone position and hang their arm over the edge of the table. Place your fingers superior to the spine of the scapula. When abduction of the arm is carried out in this position, the contraction of the Subscapularis muscle may be felt.
Choice A corresponds to palpation of the Supraspinatus muscle, not the Subscapularis. The Supraspinatus originates from the supraspinous fossa of the scapula, and its muscle fibers converge toward the tip of the shoulder to form a short tendon that inserts to the uppermost facet of the greater tubercle of the humerus.
Supraspinatus is responsible for abduction of the humerus.
B. Have the client stand erect and abduct their arm while holding a small weight. Place your fingers superior to the spine of the scapula to feel the contraction of subscapularis.
Choice B also refers to suprascapularis, which can be palpated by placing the fingers just superior to the spine of the scapula.
C. Have the client lie in prone with the arm hanging vertically. The margin of the posterior deltoid should be identified. The palpating fingers are placed below the deltoid on the scapula near its lateral margin. While the client maintains his arm in a vertical position, request he demonstrate lateral rotation the shoulder. The Subscapularis then rises under the palpating fingers.
Choice C describes the palpation for the Infraspinatus. The muscle originates from the infraspinous fossa and inserts to the greater tubercle of the humerus.
Teres Minor is also a part of the rotator cuff group. It originates lateral border of the scapula and then inserts into the greater tubercle of the humerus. Palpation of the Teres Minor is similar to that of the infraspinatus. However, the palpating fingers should be positioned lateral to the infraspinatus and spine of the scapula.
Infraspinatus and teres minor externally rotate the humerus.
D. Have the client’s trunk inclined forward so that the scapula slides forward on the rib cage by the weight of the hanging arm. In this position, you may already palpate a portion of the Subscapularis muscle. The fingers are then placed in the axilla anterior to the latissimus dorsi and with gentle pressure, are moved into the costal surface of the scapula. With the arm hanging vertically, the client then medially rotates the shoulder. The firm, round belly of the subscapularis can be felt rising under the palpating fingers.
Choice D describes the Subscapularis muscle. Subscapularis originates from the costal surface of the scapula and inserts on the lesser tubercle of the humerus and shaft distal to the tubercle. It is responsible for internal rotation of the humerus.
Choice D suggests how to palpate for the Subscapularis muscle.
Further learning about the rotator cuff.
Name the action of this muscle:
- Supinates forearm and assists with extension of the elbow.
- Pronates forearm and assists with flexion of the elbow.
- Supinates forearm and assists with flexion of the elbow.
- Pronates forearm and assists with extension of the elbow.
Breaking Down the Question
This question may cause panic as you wonder how you are going to answer this without being given the name of the muscle. However, you can answer this question even if you do not know the name of this muscle.
There are several muscles that act on and cross the elbow.
- Forearm flexors
- Biceps brachii
- Forearm extensors
- Triceps brachii
- Forearm rotators
- Pronator teres
Next, we need to locate the origin and insertion of this muscle.
Find the Insertion
The insertion of nearly every muscle tends to be the distal attachment. The distal attachment here is on the radius.
Mnemonic for learning the location of the Radius vs Ulna:
- Make a fist with a thumbs up. Say “Rad!”
- Your thumb is now pointing/lined up to your “Rad”ius.
Insertions move toward the the origin, or proximal attachment, during movement.
On your left arm mark (on the thumb/radius side) where the insertion of the pictured muscle would be located.
Find the Origin(s)
Next, on your medial elbow, mark the origin(s). This muscle has two heads, one on the ulna and one on the humerus.
Find the Action
Moving the insertion towards the origin produces two movements:
- Pronating the forearm
- Flexing the elbow
This answers the question. Choice B is correct.
This mystery muscle is Pronator Teres.
- Origin: Medial to the epicondyle of humerus and coronoid process of ulna
- Insertion: Midlateral shaft of the radius
- Action: Pronates forearm, Assists in flexing elbow
(You may feel awkward, but it is totally OK to use your body for reference during your MBLEx exam!)
That’s it for today!
Tomorrow, you will get to apply your multiple choice skills in the last lesson, where you complete a 25 question mini-MBLEx simulation.
Feeling overwhelmed or panicky? That’s okay! We will cover exam anxiety, too.